Provider Demographics
NPI:1508379868
Name:FIVE STAR TRANSPORTATION SERVICES LLC
Entity Type:Organization
Organization Name:FIVE STAR TRANSPORTATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MERGA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOONAA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-777-0707
Mailing Address - Street 1:4111 CENTRAL AVE NE STE 209
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-2957
Mailing Address - Country:US
Mailing Address - Phone:763-229-5470
Mailing Address - Fax:
Practice Address - Street 1:4111 CENTRAL AVE NE STE 209
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-2957
Practice Address - Country:US
Practice Address - Phone:763-229-5470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)